CERTIFICATE OF LIABILITY INSURANCE (9)
~ AC~RDN CERTIFICATf ~F LIABILITY INSURANC OP ID 2" DATE (MMlDDIYYYY)
MARI:N-2 04/29/08
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Mutual Insurance Agency at Clw HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 1779 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Clearwater FL 33757
Phone: 727-446-6064 Fax:727-442-9751 INSURERS AFFORDING COVERAGE NAlC#
INSURED INSURER A: Auto Owners Ins Co 09703
INSURER B: .
Marina Dental & Denture INSURER c:
Clinic PA
25 Causeway Blvd., Ste. 20 INSURER D:
Clearwater FL 33767-2099
. . INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
POLICY NUMBER POL~1:~d'8~E POLlC!IFXPI~~N LIMITS
LTR NSRI TYPE OF INSURANCE DATE MMlDD DATE MM/DD
GENERAl LIABILITY EACH OCCURRENCE $ 1000000
I--
A X X COMMERCIAL GENERAL LIABILITY 92-178132-00 06/03/08 06/03/09 UAMAut $ 50000
PREMISES (Ea oCQJrence)
I CLAIMS MADE [!J OCCUR MED EXP (Anyone person) $ 5000
PERSONAL & ADV INJURY $ 1000000
GENERAL AGGREGATE $ 1000000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-,~~OPAGG $
Xl. POLICY -n r~g: n LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- (Ea accident) $ 1000000
ANY AUTO
-
ALL OWNED AUTOS BODILY INJURY
I-- (Per person) $
SCHEDULED AUTOS
f----
A ~ HIRED AUTOS 92-178132-00 06/03/08 06/03/09 BODILY INJURY
06/03/08 06/03/09 (Per accident) $
A X NON-OWNED AUTOS 92-178132-00
f----
I-- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY ~', ~~-f,:'" 'Er EACH OCCURRENCE $
o OCCUR o CLAIMS MADE Ifti, "':_ 41'!~' h.:~ ~ ''': ~,:t.._ ~ AGGREGATE $
$
R ~EDUCTIBLE J IN 18 2008 $
RETENTION $ $
WORKERS COMPENSATION AND OFF'" J RECORDS A .m, I TORY LIMITS T IO~~-
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE lEGi~:l. n It SRVCS D :PT E.L. EACH ACCIDelT $
OFFICERlMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $
If yes, describe under E.L. DISEASE - POLICY LIMIT $
SPECIAL PROVISIONS below
OTHER
A BPP/RC 92-178132-00 06/03/08 06/03/09 Contents 83460
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT J SPECIAL PROVIlIIONS
City of Clearwater is named as Additional Insured.
City of Clearwater
FX 462-6957
Harbormasters Office
25 Causeway Blvd.
Clearwater FL 33767
CANCELLATION
CITl 0 1 0 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY ~..AMY~ UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES. ..-./' '.
AUTHORIZED REPRESENTATIVE
."
CERTIFICATE HOLDER
John Ga
@ACORDCORPORATION 1988
ACORD 25 (2001/08)